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101 Oakland Street, Trenton NJ 08618
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(609) 989 – 7333
info@millhillcenter.org

educando a la juventud

Educación preescolar
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Exploradores STEM de la escuela intermedia

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Mayor’s Summer Youth Employment Program (SYEP)

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Trenton Area STEM Council
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Millhill’s STEM Program Ignites Passion in Local Youth

Millhill’s STEM Program Ignites Passion in Local Youth

Last night, Millhill Child and Family Development proudly concluded its 6-week STEM program, a transformative journey for 31 local students. The event was marked by an inspiring showcase where these young innovators presented their favorite projects, offering a...

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Summer Forms for SYEP/ STEM

Parent/ Guardian First and Last Name(Requerido)

Primero Último

Your Child's First and Last Name(Requerido)

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Select the program your child is participating in:(Requerido)

Summer Youth Employment Program (SYEP)

STEM Explorers

One Call Enrollment(Requerido)

One Call allows Millhill to contact parents to improve ongoing communications. Please provide up to four cell phone numbers to be included in our system.

One Call # (2)

One Call # (3)

One Call # (4)

Allergies (Check all that apply)(Requerido)

No known allergies

Food Allergies (if yes, please provide details below)

Medication Allergies (if yes, please provide details below)

Environment related allergies (if yes, please provide details below)

Other (if yes, please provide details below)

Details about allergies

Medical conditions (Check all that apply)(Requerido)

No known medical conditions

Chronic ear infections (if yes, please provide details below)

Seizures (if yes, please provide details below)

Asthma (if yes, please provide details below)

ADHD (if yes, please provide details below)

Diabetes (if yes, please provide details below)

Bleeding disorder (if yes, please provide details below)

Muscular- Skeletal Disorders (if yes, please provide details below)

Heart Disease (if yes, please provide details below)

Hypertension (if yes, please provide details below)

Hernia (if yes, please provide details below)

Other (if yes, please provide details below)

Details about medical conditions

Please list all medications your child is currently taking (prescription and over the counter):

Name and phone number of your child's physician:(Requerido)

Please provide the date of your child's last physical:(Requerido)

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Please provide the date of your child's last tetanus shot:(Requerido)

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In case of emergency, in the event that I nor the emergency contact can be reached, I hereby authorize Millhill to take any action deemed necessary for the best interests of my child, including transportation for emergency room treatment.(Requerido)

Yes, I give consent

No, I do not give consent

Millhill Child and Family Development will safeguard your protected health information. We will only use medical information in the event of an emergency for the purpose of informing medical personnel.(Requerido)

I have read and acknowledge this information.

Signature

By signing below, I give consent for my child to participate in the Millhill STEM Explorers Summer Program, which includes field trips, outdoor walks, and photos/videos of my child participating in STEM program activities which may be used for Millhill's public relations (sign below).

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Desde 1971

Millhill es una organización sin fines de lucro que brinda servicios de educación, asesoramiento y salud a niños y familias para empoderar y transformar la comunidad de Trenton, Nueva Jersey.

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101 Oakland Street, Trenton NJ 08618
OBTENER LAS DIRECCIONES
(609) 989 – 7333
info@millhillcenter.org

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